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Zika virus: Threat, treatment, prevention

The Zika virus (ZikV) belongs to the same family of viruses as dengue, West Nile Virus, and Yellow fever. It is carried by the same mosquitoes that carry dengue and chikingunya and is currently being spread through virtually every Central and Northeastern South American country. The symptoms of Zika are similar to that of many tropical flu-like illnesses and include sudden onset of fever, rash, joint pain, and eye redness. They tend to last a week or less. Symptoms are typically not very severe and seldom require hospitalization. It is thought that only 20% of infected individuals even notice that they have the disease. There are tests that have been developed for the Zika virus. Where available, individuals with suspicion for the illness may receive a blood test if their symptoms began within a week of testing.

Although one may be diagnosed with a ZikV infection, unfortunately, there is no current cure. Research is being done to create a vaccine, but none are yet available. The treatment is to support symptoms by resting, staying hydrated, and treating fever and pain. Acetaminophen should be used instead of ibuprofen because Zika could be confused with dengue and ibuprofen can complicate a dengue infection. Pregnant women should always use acetaminophen over ibuprofen regardless.

The most important thing for an infected mother is to take care of herself. She should focus on staying rested, hydrated, and well fed. Where ultrasounds are routinely performed in pregnancy, they can be helpful in tracking the child’s growth and head size but just as there is not an effective treatment for the mother there is none for her baby either. After your infant is born, depending on your area’s resources, testing may be performed on the placenta and umbilical cord of a child born with microcephaly for Zika and dengue.

Focus should be on prevention of Zika spread rather than treatment. The virus is carried by day-biting mosquitoes that especially like to reside in standing water sources. Pregnant mothers (and everyone for that matter) would be wise to use mosquito repellent, wear long sleeves and pants, and avoid areas known to be highly concentrated with mosquitoes. Empty all areas with standing water around your living quarters as well. Examples are potted plants, wash basins, abandoned tires, and dog bowls. Persons known or suspected to be infected should also avoid mosquitoes as humans also infect mosquitoes and allow them to carry to other susceptible individuals. ZikV has been found in human semen suggesting that the virus may also be spread by sexual contact. Men who have had Zika-like symptoms should avoid intercourse within a week of symptoms without a condom. As of now, there is no evidence to suggest that having a previous Zika infection will have an effect on future pregnancies.

ZikV has been around for over sixty years. It was originally found in Africa and spread to South East Asia but in the past two years, a rapidly increasing number of cases are being reported in Central and South America and many Caribbean islands. It is becoming more of a public health concern as a rise in the number of infants with microcephaly (small heads) is being reported in Brazil in the same area where Zika has been spreading.

Brazil usually reports only 150 cases of microcephaly per year and they have now reported almost 5,000 in less than 6 months. These numbers may be overestimated as on further examination over 700 of those reported babies did not have microcephaly. In any case, this is still a much higher number than previous reports. Seventeen of those documented cases tested positive for the Zika virus by blood test and there has been at least one deceased infant that was diagnosed with Zika by a brain autopsy. This suggests that there may be a link between ZikV and microcephaly.

While there is initial evidence to suggest that ZikV is a cause of microcephaly, it is still not proven. Out of the initial 732 cases examined, thirty-one percent were determined to be caused by the Zika virus or other infections. The testing process may also need some refinement as it can be difficult at time to distinguish from old infections or other similar viruses. Some questions have been raised about Zika’s culpability as there has been a similar rise in Zika infections in Colombia without the rise of microcephaly. This could still be, however, because the virus spread to Colombia later and the affected mothers have not yet given birth. The bottom line is that ZikV is suspicious for causing the sudden rise in microcephaly but has not yet proven to be the cause. More research is being done and more questions need to be answered before we can determine the full weight of its responsibility.

I believe the proper response to the threat of the virus is one grounded in reason and trust in our sovereign God (2 Timothy 1:7). While we do not have all of the answers, He does. That alone is enough for us to continue boldly in love and carry out the work to which He has called us. We need to be sensible, and just as measures should be taken to not spread dengue, chickingunya, and malaria, the same measures should be applied to prevent the spread of ZikV. Pregnant women and even those of child-bearing age should be especially vigilant as we do not yet know how soon after conception the virus can affect the developing baby.

An important point to make is that all cases of microcephaly are not caused by Zika and all cases of Zika do not cause microcephaly. It can be caused by many other infections, such as toxoplasmosis, VZV (Chickenpox and Shingles virus), Rubella, CMV, and the Herpes Virus. It can also be caused by exposure to drugs, alcohol, and other toxic ingestions. It can be caused by malnutrition, maternal medical conditions that affect blood flow her baby, and unpreventable genetic abnormalities. Many pregnant women have been infected by ZikV and gave birth to perfectly healthy babies.

It is also unfair to equate microcephaly to a death sentence. The degree of impact of this condition varies greatly. While some affected children are stillborn or live only hours after birth, others have normal intelligence and exhibit no symptoms of disease aside from a number on a head circumference chart. Most children will have some degree of impairment which may include intellectual disability, seizures, vision, and speech problems which vary in severity.

In light of all this, one should be wary of any advertisements offering abortive medications based on the results of a positive ZikV blood test. Aside from being an illegal action in the majority of countries where this is being offered, it is coming from a body of individuals who are re-acting in panic and have a flippant attitude towards life. If ZikV causes microcephaly, AND the blood tests are accurate enough to determine definitely and specifically that one has an active infection, then a positive test still does not imply necessarily by any means that the baby will be born microcephalic. Then, even if they baby is born with a small head their quality of life cannot be determined until after birth and their value to their families and society certainly cannot be measured until long after their death.

To look beyond the questions surrounding how involved ZikV is in the outcomes of these newborns, let’s look towards our Savior. He is the One who stepped away from his throne, to seek us out, and save us from ourselves when we were his enemies. We were bent towards our own flesh and our own will (Ephesians 2:1-10). While we may have been born with an average sized head, we were born with a wicked heart and deserved God’s wrath and eternal punishment. But God looked at us in His grace and decided that as deformed as our hearts were, they were worth saving. We ought to feel confident that if He chose to save us in our filthy spiritual condition, we have no fathomable right to determine whose potential physical condition is worth protecting in the womb. Following His example, we are responsible to be the voice of an unborn child who cannot stand up for himself. As we are prone to pride and selfishness, let us leave the decisions about who lives and dies to our merciful, all-knowing Father and speak with confidence against those who wage war against Him.

Michael Heiland, MD, grew up in a family of six children where his parents, Ken and Melissa, taught them to seek after God and follow His principles. "I haven't always done this, but I did try to choose medicine as a career to serve the Lord and the less fortunate." He spent most of his life in Florida and went to medical school there before leaving to train at Via Christi Family Medicine residency program in Wichita, KS, where he currently practices. He and his wife Lauren have a six-month-old daughter, Graciana Hope. He also serves as the medical director for Beautiful Feet International, which was founded by his parents.